Dental reforms failing to improve NHS services

New contractual arrangements for dentists were designed to increase the number of people who access NHS dentistry. However, a report by MPs suggests they have not succeeded.

The changes were introduced in April 2006 in the face of widespread discontent with the previous system, both from patients and dentists. The main problems were the lack of NHS dentists, leading to problems accessing NHS care in some areas, and an overcomplicated fee structure with over 400 separate charges for different procedures. It meant dentists had a financial incentive for carrying out complex dental procedures, rather than preventing problems, and often left patients unclear on what their dental treatment would cost.

Dentists rather than having the uncertainty and complexity of charging the NHS for every item they carried out, now have a fixed annual payment depending on the level of treatment they provide.

For patients, the charging system was simplified to three bands of fees.

Currently, for a simple examination, x-ray, or scale and polish the fee is £16.20, rising to £44.60 for more complex treatments such as fillings, extractions, or root canal work. People who need the most time consuming work, such as bridges, dentures or crowns pay the highest fee, £198.

The introduction of three charging bands meant that while some complex procedures cost less, the cost of some routine treatments, such as fillings, increased. Dentists’ groups say the amount of time available for preventative work is insufficient.

The report from the House of Commons Health Committee, says that the new contract has yet to resolve the fundamental problems that dogged old-style NHS dentistry. The number of patients without an NHS dentist is roughly the same, and the same patchwork of cover persists, with one town amply provided with NHS dentists, while another close by might have long lists of people waiting for an available place.

The Health Committee report offers evidence that the number of complex treatments carried out has fallen as a result of the changes, with the number of root canal treatments falling by 45% in the first year of the reforms. At the same time, the number of extractions has risen. It found that nationally fewer patients are visiting an NHS dentist than before April 2006.

The Health Committee wants changes to the way dentists are paid which would reward them more highly for appropriate treatments.

The report painted a much more optimistic picture of the private sector, noting that while the number of NHS dentists and their activity levels have fallen since 2005-06, private sector dentistry appears to have grown.

People have been voting with their feet, buying dental insurance, going private or going overseas for treatment.